Draft – DARS Strategic Plan
DRAFT Department of Assistive
and Rehabilitative Services
The material in this chapter is arranged as follows:
- Challenges and Opportunities;
- Cross Agency Coordination and Planning Initiatives
- Current Activities by Goal:
- Target Populations;
- Service Descriptions; and
- Trends and Initiatives;
- Internal Assessment.
To work in partnership with Texans with disabilities and families with children who have developmental delays to improve the quality of their lives and to enable their full participation in society.
The department's enabling statute is found in the Human Resources Code, Chapter 117. DARS also has numerous statutes for its legacy agencies.
DARS administers programs that ensure Texas is a state where people with disabilities and children with developmental delays enjoy the same opportunities as other Texans to live independent and productive lives. The Department has four program areas: Rehabilitation Services, Blind Services, Early Childhood Intervention Services, and Disability Determination Services. Additionally, the Office of the Deputy Commissioner administers the Autism program. Through these program areas, DARS provides services that help Texans with disabilities find jobs through vocational rehabilitation, ensure Texans with disabilities live independently in their communities, and help children with disabilities and developmental delays reach their full potential.
Challenges and Opportunities
MOA with Veterans Affairs
The United States Department of Veterans Affairs (DVA) estimates the total number of veterans in the country to be 23,067,000.1 Military veterans returning to Texas from duty overseas represent a population that may benefit from increased access to programs at DARS. Historically, the department has had a memorandum of agreement (MOA) with the DVA-Vocational Rehabilitation and Employment Services (DVA-VRE) program. The objective of this MOA was to coordinate vocational rehabilitation and independent living services with those provided by DVA-VRE to maximize services and improve outcomes.
Currently, DARS is revising the MOA, which is expected to be finalized before the end of FY 2010, to include a focus on coordination of services to veterans with traumatic brain injury (TBI) and traumatic spinal cord injury (SCI) in addition to traditional vocational rehabilitation services. DARS provides TBI and SCI assistance under its Comprehensive Rehabilitation Services (CRS) program, through contracts with independent providers around the state. DVA-VRE provides similar services, but in more limited geographic areas. The MOA sets forth the framework each agency will follow in order to provide a clear understanding of services provided by each agency, methodology for making referrals and sharing information between agencies, and system for coordinating services available from each agency. Eligible veterans may also receive additional services through the DARS CRS program when those services are unavailable through DVA-VRE.
Veterans with traumatic brain injury and spinal cord injury seek CRS services in very small numbers. Over the last eight years, five to seven percent of consumers in the CRS program have been veterans. Although this percentage has not been increasing, recent projections suggest a rise in the number of veterans diagnosed with TBI and SCI.
Change in Vocational Rehabilitation (VR) Funding Formula
A Government Accountability Office report released in September 2009 suggests a change to the method by which the Vocational Rehabilitation (VR) program is funded.2 If Congress amends the Rehabilitation Act to include this change to the funding formula, DARS may lose between $5.1 million and $14.5 million per year in its VR programs. This loss of funds would be detrimental to the program and require DARS to submit a request for an Order of Selection to the Rehabilitation Services Administration (RSA). Under an Order of Selection, only those individuals with the most significant disabilities would be served and consumers who would have previously received services would be ineligible. For general disabilities, this means that individuals with a wide variety of diagnoses such as learning disabilities, amputations, congenital disorders, or mood disorders may not receive services because the severity of the disability would not be substantial enough to meet the new criteria.
Because DARS is uncertain as to which funding proposal may be adopted, if any, the agency is unable to predict how many Texans would be affected.
Consumers referred through Workers Compensation
Consumers referred to the DARS Vocational Rehabilitation program from the Worker's Compensation system have increased 10-fold since FY 2009. This increase in referrals is putting additional demands on Vocational Rehabilitation Counselors, whose caseloads are already large. This population of potential VR consumers requires a specialized level of experience, skill and time commitment beyond the current capacity of general VRCs.
Strengthening the Statewide Network of Centers for Independent Living in Texas
Independent living services—from early childhood intervention to senior services, from vocational placement to community integration—are an integral part of the continuum of assistance essential to persons with disabilities. Independent Living Centers (CILs) are community-based, non-residential organizations that provide independent living skills training, individual and systems advocacy, peer counseling, and information and referral services to people with significant disabilities. These services help people with disabilities live more independently, avoid living in an institution, and where appropriate, obtain employment. CILs have made significant efforts to assist individuals living in institutions to relocate to community living. Serving people with disabilities in the community has been shown to be less expensive than institutional settings.
Centers play an important role as a critical link to the service delivery systems of other health and human services programs in local communities. The Centers provide expertise in navigating the array of community services that otherwise may not be discovered by a person with a severe disability. Centers also respond to the local needs of their communities by providing additional, specialized services. Currently there are 26 CILs in Texas. Stakeholders, including the Statewide Independent Living Council, would like to see continued expansion of the CIL network and increased funding of existing CILs.
Cross-Agency Coordination and Planning Initiatives
Strategic Relationship with Workforce System
The Texas Workforce Investment Council (TWIC) serves as the Workforce Investment Act's (WIA) required State Workforce Board in Texas. The DARS Commissioner acts as the Health and Human Services Commission's (HHSC) Executive Commissioner's designee. TWIC, in collaboration with system partner agencies, including HHSC and DARS, has developed Advancing Texas: Strategic Plan for the Texas Workforce Development System (Fiscal Year 2010 to Fiscal Year 2015)—the strategic action plan developed by the Governor on October 23, 2009. Certain DARS performance measures—consumers served, employment retention, and number of consumers who entered employment—are included in the TWIC annual report.
Because the Rehabilitation Act appears as Title IV of the Workforce Investment Act, there is a direct connection between Vocational Rehabilitation programs and the WIA activities at the state and local workforce levels. This connection emphasizes the importance for DARS and its consumers to work in partnership with TWIC and system partners to share relevant performance data and to foster stronger relationships at the state and local levels.
Current Activities by Goal: Target Populations, Service Descriptions, and Trends and Initiatives
DARS Goal 1: Children with Disabilities
DARS will ensure that families with children with disabilities receive quality services enabling their children to reach their developmental goals.
Texas Health and Human Services System demographers analyze data obtained from the American Community Survey (ACS) for Texas and the National Health Interview Survey (NHIS), in addition to population projections data developed by the Texas State Data Center (SDC), to develop estimates of the population-in-need for the Blind Children's Vocational Discovery and Development (BCVDD) program and Deaf and Hard of Hearing Services.
The ACS is the source used to calculate age-specific prevalence rates of visual and hearing impairment in the Texas population. The NHIS is the source used to calculate age-specific prevalence rates for blindness and deafness among the vision and hearing impaired populations, based on a national sample. The ACS prevalence rates for visual and hearing impairment are then applied to population projections for corresponding age groups to develop projections of the population with vision and/or hearing impairments. The NHIS prevalence rates for blindness and deafness are applied to the projected population with vision and hearing impairment to develop projections of the blind and deaf populations.
The rate developed by the above analysis for the population of children from birth to 9 years of age is applied to the population projection for that age group to calculate to population in need for the Blind Children's Vocational Discovery and Development (BCVDD) program.
The ECI program is required by Part C of the Individuals with Disabilities Education Act (IDEA) to serve all eligible children under the age of three. Currently, the U.S. Census and the American Community Survey do not collect disability data for the population under five years of age. Therefore, caseload forecasting methodologies developed by HHSC are used to project the number of children who will be served.
Early Childhood Intervention Services
The ECI program serves families with children birth to 36 months with developmental delays or disabilities. ECI services are available to all eligible children. Children are eligible for comprehensive ECI services if they meet any of the following criteria:
- A diagnosed physical or mental condition that has a high probability of resulting in a developmental delay;
- A documented delay in one or more of the following areas of development: cognitive, physical/motor, speech/language, social/emotional, and adaptive/self-help; or
- Atypical development.
ECI provides family support and specialized services to strengthen the family's ability to access resources and improve their child's development through daily activities. As required by the Individuals with Disabilities Education Act (IDEA), Part C, the following comprehensive array of services are available:
- Assistive technology;
- Early identification, screening, and assessment;
- Family counseling;
- Family education;
- Health services;
- Home visits;
- Medical services;
- Occupational therapy;
- Physical therapy;
- Psychological services;
- Service coordination;
- Social work services;
- Developmental services;
- Speech language therapy;
- Transportation; and
- Vision services.
Children are referred for early intervention services by family physicians, hospitals, family friends, social workers, day care providers, or others familiar with the child and with early intervention services. After entering services, families and service providers work together to develop an Individualized Family Service Plan. Family-centered services are provided to help achieve the goals identified in the plan. Children and their families generally receive services in their natural environments—where children typically learn, live, and play, and where children without disabilities participate in daily activities.
In FY 2009, comprehensive services were provided to 57,110 children with developmental disabilities or delays. Services were provided through 58 community-based programs. These programs include the following types of public and private community-based organizations:
- 28 community/state mental health and mental retardation centers;
- 16 private non-profit service organizations;
- 7 regional educational service centers;
- 5 local independent school districts; and
- 2 other agency types.
Trends in the Early Childhood Intervention Services Population
The ECI program has seen significant growth in the number of children served over the past several years, with annual increases of greater than seven percent in the last two years (see Table 6.3). Much of this growth can be attributed to a greater awareness and knowledge among parents and caretakers concerning developmental issues affecting their children. Also, the increase in research on the impact of early intervention on early brain development has contributed to this increased awareness and recognition. The growth in the number of children needing services can also be explained by changes in factors that increase the risk of children having developmental delays or disabilities. These include growth in the number of children who are born pre-term and/or with low birth-weights and increased survival rates of children born with medical problems or complications.
Data from the National Center for Health Statistics indicate that the percentage of children born with low birth-weight in Texas increased from 7.4 percent in 2000 to 8.4 percent in 2006. In that same year, 13.7 percent of infants in Texas were pre-term. Prematurity is a major determinant of illness and disability among infants, including developmental delays, chronic respiratory problems, and vision and hearing impairment. However, as a result of early intervention services, many children attain significant and lasting developmental progress and meet developmental outcomes. Historical and recent trends reflect increasing recognition that the first few years of a child's life are a particularly sensitive period in the process of a child's development.
ECI programs must be prepared to serve children with complex and specialized needs. Of the children eligible due to developmental delays, the percentage of children with delays in multiple areas has increased from 37 percent in 2004 to more than 50 percent in 2009. More children also have specialized needs, including autism, intensive medical needs, and auditory and/or visual impairments. In addition, changes enacted in the state in 2007 required each child under the age of three who is the subject of a substantiated case of abuse or neglect to be referred from Child Protective Services (CPS) to ECI. As a result, ECI now serves more children who are involved with CPS. Many of these children and families also require more frequent and intensive services.
Additionally, there are funding implications for the provision of services with such intensity and frequency. This increase in service needs over the past several years has occurred without corresponding increases in the ECI cost per child budgeted amounts. The increases have not kept pace with increasing therapist salaries and additional initiatives implemented by ECI. This salary increase and the shortage of therapists who provide the range of services required by IDEA, including, speech, physical, and occupational therapy continue to be a challenge to the ECI program.
For these reasons, DARS is evaluating the ECI program (further discussed in the internal challenges). The goal of this evaluation is to develop recommendations for a sustainable ECI program that can effectively serve children and families.
Trends in Referrals and Enrollment
in Early Childhood Intervention Comprehensive Services
|Fiscal Year||Referrals||Percentage Change||Average Monthly Enrollment||Percent Change|
Table 6.1: Department of Assistive and Rehabilitative Services, 2009.
Blind Services for Children
The Blind Children's Vocational Discovery and Development (BCVDD) program focuses on services for children from birth through age nine. Youth ages 10 and older are referred to the Blind Services (DBS) Transition Services program. However, the BCVDD program continues to provide services for those children ages 10-21 who do not meet the eligibility criteria for the Transition Services program. Projected population data for the planning period are listed in table 6.1 below.
Service Populations Projections
for Child Blindness and Visual Impairment in Texas
|Age||FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
Table 6.2: Department of Assistive and Rehabilitative Services, 2009.
The BCVDD Program provides opportunities for children who are blind or severely visually impaired to increase the skills required for personal independence, potential employment, and other life pursuits.
Specialized services include counseling and guidance for children and their parents regarding adjustment to blindness and the impact of blindness on development, educational support, information and referral, independent living training, and developmental equipment. These services foster vocational discovery and development while promoting the child's self-sufficiency, thereby decreasing the need for services later and giving the children a solid foundation when they enter the world of work. The program emphasis is on serving children who are permanently and severely visually impaired.
Trends in the Blind Children's Target Population
The number of babies born in the U.S. with severe visual impairments and blindness is increasing.3 With advances in modern technology, more babies with multiple disabilities are surviving. Additionally, the Texas Education Agency (TEA), a primary source of referrals to the program, reports an increase in the number of blind and visually impaired children who receive special education services. Blind and visually impaired students increased by 705 from school year 2006 to 20104.
These permanently and severely visually impaired children, many of whom have other multiple disabilities, have complex needs and require a variety of service delivery options. Specialists face multiple challenges when delivering the array of services these children and their families require and must have comprehensive knowledge of resources, disabilities, interventions, training, assistive technology, and support systems.
Specialists can provide effective and timely services with a caseload size at or below 69. The program served 3,503 children in FY 2009, an increase of 8.8 percent. Due to increased networking with special education providers, program referrals have increased and certain Texas regions have exceeded the targeted maximum caseload size.
The Autism Program provides services for children three through eight years of age with an autism spectrum disorder. An autism spectrum disorder incorporates diagnoses of Autistic Disorder, Pervasive Developmental Disorder – Not Otherwise Specified, Rett's Disorder, Asperger's Disorder, and Childhood Disintegrative Disorder.
The Autism program provides the following services, as determined by the individual needs of the child:
- Applied behavior analysis (ABA) treatment
- Audiology evaluations
- Psychological testing
- Speech-language therapy
- Physical therapy
- Occupational therapy
- Home-based services
Autism services are provided by the following contractors:
- Any Baby Can, San Antonio
- Center for Autism and Related Disorders, Austin
- Child Study Center, Fort Worth
- Easter Seals North Texas, Dallas
- MHMRA of Harris County, Houston
- Texana Center, Rosenberg
Projections of demand for Autism Program
|Fiscal Year||FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
Table 6.3: Department of Assistive and Rehabilitative Services, 2009.
Trends in the Autism Program Target Population
Autism spectrum disorder (ASD) is the fastest-growing serious developmental disability in the United States, affecting an estimated 1 percent of children. The Centers for Disease Control recently reported that 1 in 97 children in the United States has an autism spectrum disorder (ASD). The demography team in the Office of Strategic Decision Support at HHSC estimated that in 2008 there were 50,100 Texas children under age 21 with ASD. This translates into approximately 21,060 children ages 3 through 8 in need of autism services. With the number of children being diagnosed with ASD growing at an alarming rate, there continues to be an unmet need for autism services in Texas.
The DARS Autism Program was developed as an attempt to mitigate this need. Though an increase in funding allowed for limited growth to two additional geographic areas, services are still not available in many areas of the state. The current six DARS contract providers have over 600 children waiting for services on interest lists.
DARS Goal 2: Persons with Disabilities
DARS will provide persons with disabilities quality services leading to employment and independent living.
Vocational Rehabilitation (VR) and independent living (IL) services for adults and youth are available for people with general and visual disabilities. DARS also serves Texans who are deaf or hard of hearing.
Vocational Rehabilitation Services
To project the population potentially eligible for VR services, HHSC demographers use the American Community Survey (ACS) to calculate the prevalence of work-related disabilities in the working age population (age 16-64), broken down by age group. They also use the ACS to calculate the prevalence rate for severe visual and hearing impairments within the population with work disabilities. Those rates are then applied to projections of the working age population obtained from the Texas State Data Center to project the number of working age Texans with a work disability, and the number of working age Texans with a work disability with severe hearing and vision impairments.
Age-specific prevalence rates for blindness and deafness obtained from the National Health Interview survey are then applied to the projected number of persons with work disabilities with severe hearing and vision impairments (as described above) to obtain projections of the number of Texans with a work disability who are blind and/or deaf.
Vocational Rehabilitation — Blind
DBS assists Texas adults and youth who are either blind or significantly visually impaired, to meet their employment and independent living needs. The program offers a variety of skills training, accommodations, and adaptations, which are tailored to each consumer's skills, abilities, and interests. The principle of informed consumer choice guides the provision of services, with the ultimate goal of helping consumers function as independently as possible in employment consistent with their skills, abilities, and interests.
The Texas population growth has a direct impact on the blind and visually impaired population. The number of people potentially eligible for services is estimated to increase significantly during this planning period. It is expected that the VR program population will increase by almost 10,000 individuals and the IL program population by almost 15,000 individuals.
Counselors can provide effective and timely services with a caseload size at or below 66. The statewide caseload average is within the target caseload size; however, several regions of Texas are significantly higher. Texas' large metropolitan areas such as Dallas, Houston, Austin and San Antonio are significantly over the average caseload size. Caseloads exceeding the targeted caseload size are difficult to manage, resulting in an uneven distribution of services to consumers. Additional caseloads are needed to reduce caseload sizes in these areas and ensure consistency of services across Texas.
The VR—Blind program provides services for eligible individuals consistent with their strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. Work-related services are based on individual needs and are geared toward providing eligible adults with the wide range of skills, equipment, and services they need to enter employment, keep their jobs, or return to the workforce after losing their vision. Some of the available specialized services are listed below:
- Guidance and counseling to assist the consumer and their family with a plan to reach an employment goal and live confidently and independently;
- Employment Assistance Services to prepare a consumer for employment, and to assist the consumer in securing suitable employment;
- Assistive technology to assist with employment or attaining education or training leading to employment;
- Orientation and mobility training to assist with traveling independently in their work and home environment;
- Personal and home care training to ready the consumer for an employment lifestyle;
- Job retention services such as training in adaptive skills and equipment for the consumer to maintain a current job;
- Vocational training to learn job skills as well as training on how to pursue and maintain employment;
- Communication/Braille skills to successfully interact at work and in the community; and
- Intermediary assistance with existing and potential employers.
Empowerment is the key to a consumer's success in employment and living independently. It is critical for the consumer to have a positive attitude, high expectations, and mastery of basic blindness skills. The majority of society believes that blindness severely restricts an individual's capabilities, resulting in the common misconception among employers and others that blind people cannot work or even live independently. The ultimate goal of the rehabilitation program is to help consumers to use all their options and to instill in them the confidence to independently move ahead with employment and life.
Advances in technology have opened many doors in the world of work for people who are blind or visually impaired. As part of its overall consumer training program, DARS maintains an Assistive Technology Unit. This unit evaluates consumer needs and provides the consumer and the VR counselor with recommendations regarding the best equipment to meet the consumer's employment and training needs.
To meet the vocational needs for individuals with the most severe disabilities, supported employment services are provided to help consumers obtain competitive employment. Specially-trained job coaches/trainers provide consumers with individualized, ongoing support needed to maintain employment. Program enhancements have been introduced to further promote successful employment for this target population.
The VR counselors work with a variety of sources to ensure that individuals gain the independent living skills, experience, training, and education to reach their employment outcome. The program served 10,144 blind people in FY 2009.
The Transition Services program provides age-appropriate VR services to eligible youths at least 10 years of age and older. Transition services is an outcome-oriented process promoting movement from school to post-school activities, including secondary education, vocational training, integrated employment including supported employment, continuing education, independent living, and community participation. This program prepares youth, including those with multiple disabilities, to make informed choices about their future. Consumers develop appropriate skills to transition from the educational environment to the adult community successfully. The program served 1,941 youth in FY 2009.
The Business Enterprises of Texas (BET) program, authorized under the federal Randolph-Sheppard Act, develops and maintains business-management opportunities for legally blind persons in food-service operations and vending facilities located on public and private properties throughout the state. This program assisted 118 individuals in food service employment in FY 2009. BET continues to receive a large number of applications, which requires the program to increase the number of new food service facilities by two in each year of the biennium. Additional funds to refurbish existing facilities also are necessary. The program must also address increased maintenance costs such as vehicle replacements, fuel, equipment repairs, and equipment replacements, which are anticipated to increase as a result of inflation. BET is entirely funded by revenues generated from vending machines on state property and expansion would not require general revenue.
The Criss Cole Rehabilitation Center, located in Austin, is the agency's comprehensive rehabilitation facility serving blind Texans. CCRC accepts referrals from other states as well. Services are typically provided in a residential setting. At the center, consumers receive individualized, intensive training and support in developing the confidence to use various alternative skills and techniques. Training includes courses such as Braille, orientation and mobility, technology, college preparatory classes, preparation for BET skills training, daily living skills, and career guidance. Upon completion of training, consumers return to their communities and use their new skills and confidence to seek employment, enroll in college, or vocational training, or pursue other opportunities commensurate with their goals. This program served 512 individuals in FY 2009.
Vocational Rehabilitation -- General
The VR—General program, a state-federal partnership since 1929, helps eligible Texans with disabilities overcome vocational limitations and enables them to prepare for, find, and keep jobs. Together, a consumer and a counselor determine an employment goal for the consumer that is consistent with the consumer's strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.
Work-related services are based on individual needs and may include a variety of services, including the following:
- Medical, psychological, and vocational evaluation to determine the nature and degree of the disability and the consumer's job capabilities;
- Counseling and guidance to help the consumer and the family plan vocational goals and adjust to the working world;
- Training to learn job skills in trade school, college, university, on the job, or at home;
- Hearing examinations, hearing aids, and other communication equipment, aural rehabilitation, and interpreter services for the deaf and hard of hearing;
- Medical treatment and/or therapy to lessen or remove the disability;
- Assistive devices such as artificial limbs, braces, and wheelchairs to stabilize or improve functioning on the job or at home;
- Rehabilitation technology devices and services to improve job functioning;
- Training in appropriate work behaviors and other skills to meet employer expectations;
- Job placement assistance to find jobs compatible with the person's physical and mental ability;
- Supported employment services; and,
- Follow-up after job placement to ensure job success.
The principle of informed client choice guides the development of the consumer's plan. After the Individualized Plan for Employment (IPE) is developed, counselors use case service funds to purchase services needed to achieve the employment goal. Counselors have the authority to purchase services for consumers in accordance with federal and state law and department policy.
As part of the VR program, counselors across the state provide transition planning services to eligible students with disabilities to assist with the transition from high school to employment or further education. These counselors actively seek students with disabilities who are enrolled in regular and special education, to provide them information about the availability of VR services. Currently, the VR program has 101 positions dedicated to serving only transition students within high schools. These Transition Vocational Rehabilitation Counselors (TVRCs) work in approximately 430 predominately 5A and 4A high schools across Texas serving students with disabilities. There are over 2,100 public high schools in Texas. More TVRCs are needed to serve additional 5A, 4A, and 3A high schools. Due to the special needs of deaf students, there is also a need for specialty deaf counselors to work with the regional day school programs for the deaf. These counselors will be able to provide the communication access the students need to fully participate in their transition planning. Each region also has a Regional Transition Program Specialist available to counselors to facilitate cooperation with local school districts and other state agencies promoting transition-planning services. In Texas, 7,968 students were served during FY 2009.
To be eligible for the VR—General program, an individual must:
- Have a physical or mental impairment that constitutes or results in a substantial impediment to employment;
- Require VR services to prepare for, enter, engage in, or retain gainful employment consistent with the consumer's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice; and
- Be able to get and keep a job after receiving services.
Note: Individuals who receive Social Security Disability Insurance and Supplemental Security Income disability benefits are automatically eligible for VR Services.
In FY 2009, more than 93 percent of the consumers served in the VR-General program had significant disabilities. The range of disabilities that had interfered with their employment included:
- 24 percent with musculo-skeletal disabilities;
- 21 percent with cognitive disabilities;
- 18 percent with mental/emotional disabilities;
- 14 percent with a variety of other impairments.
- 11 percent with deafness or hard of hearing;
- 5 percent with neurological disabilities;
- 4 percent with substance abuse disabilities;
- 3 percent with traumatic brain/spinal cord injuries;
- 2 percent with cardiac/respiratory/circulatory disabilities; and
As a result of services provided by the VR-General program, consumers found work in a variety of occupations:
- 22 percent in service industries;
- 18 percent in office and administrative support;
- 17 percent in professional or managerial positions;
- 10 percent in healthcare related positions;
- 8 percent in sales and related positions
- 7 percent in transportation and material moving positions;
- 7 percent in construction, maintenance and repair;
- 7 percent in production related positions;
- 2 percent in protective service and military; and
- 1 percent in farming, fishing, and forestry industries.
Service Population Projections for Vocational Rehabilitation
|Fiscal Year||FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
Table 6.4: Department of Assistive and Rehabilitative Services, 2009.
Increased demand for VR services
As the population of people with disabilities continues to grow in Texas, so does the demand for vocational rehabilitation services. Rehabilitation Services has seen an increase of approximately 2.4 percent each year in applications from 2007 to the end of 2009 and project an increase above 4.8 percent in the next biennium. Further, the number of Texans expected to need services is projected to increase approximately 2 percent from 2011 to 2012.
Increasing costs of VR services
The topic is currently being developed.
Increasing caseload sizes for VR
The topic is currently being developed.
Lack of VR support staff
A federal grant audit finding in January 2004 resulted in Rehabilitation Services being cited for improper payment of Comprehensive Rehabilitation Services (CRS) salaries. In compliance with Circular A-87, DRS use time sheets to track all non-VR services to ensure that salaries and operating expenses are charged to the appropriate funding stream. The effect has been an increase in utilization time and full-time equivalents (FTEs) for the CRS program with a corresponding decrease in time of FTEs working in the VR program. This has created a workforce drain against the expected results of the VR program. Additional FTEs are needed in the VR program to backfill positions lost as a result of the CRS time sheeting.
Comprehensive Rehabilitation Services (CRS)
The current method for calculating service population projections for CRS was developed by a CRS work group and utilizes data from population projections by the Department of State Health Services Center for State Statistics, Texas population data, and the Centers for Disease Control (CDC). The methodology uses estimates for the percent of Texans with insurance adequate to cover expenses related to spinal cord and traumatic brain injuries.
The CRS target population includes people with traumatic brain injury and traumatic spinal cord injury who require a special set of services. The CRS program projects the following numbers of persons potentially needing the program's services.
Service Population Projections for Comprehensive Rehabilitation Services
|Fiscal Year||FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
Table 6.5: Department of Assistive and Rehabilitative Services, 2009.
Comprehensive Rehabilitation Services (CRS), developed for people with traumatic brain injury and traumatic spinal cord injury, include inpatient comprehensive medical rehabilitation, outpatient rehabilitation services, and post-acute brain injury rehabilitation services. These services are necessary to increase an individual's ability to function independently within the family and the community. These time-limited services are designed to assist the consumer with daily living skills and to prevent secondary disabilities such as respiratory problems, pressure sores, and urinary tract infections, thereby increasing the consumer's ability to function independently.
CRS growth and capacity
The CRS program has grown from $1 million in expenditures when the program began to $18 million in state fiscal year 2010. In addition, service delivery has increased from 100 consumers initially to 625 consumers in state fiscal 2009. Consumers are served more quickly and the average wait decreased from 3.27 months to 2.94 months. Further, the number of new consumers receiving services in the first quarter of the fiscal year has increased from 172 in FY 2008 to 272 in FY 2010. Still, the size of the waiting list continues to increase while the number served each year remains relatively stable. This appears to be due, at least in part, to a paradoxical relationship between referrals and funding. When funding is very limited or not available, referrals to the CRS program decrease. When funding becomes available and people perceive there is a realistic chance of obtaining services quickly, referrals increase.
DARS has worked with providers and modified policy to ensure that that an array of services that meet the needs of consumers is provided in the most cost effective way. By decreasing the length of services in the initial service authorization, the program has challenged providers to reach rehabilitation goals more quickly and efficiently while allowing for additional services when justified. This has allowed DARS to serve a stable number of consumers despite the rising costs of services. However, the program has reached the point where greater efficiency can no longer be achieved. Without additional funding for increases in rehabilitation costs, the program will see decreases over time in the number served and increases in the wait list size.
Independent Living Services
To project the population potentially eligible for Independent Living Services (Blind), the ACS is used to calculate the prevalence rate for self-care limitations within the population with severe vision impairments, also derived from the ACS, according to age group. This rate is then applied to population projections obtained from the Texas State Data Center, broken down according to age, to develop projections of the population potentially eligible for this program.
Projections of the population potentially eligible for the Independent Living Program (General) are obtained by subtracting the projected population potentially eligible for the Independent Living Program (Blind) from the projected population of persons with self-care limitations.
Independent Living Services — Blind
The Independent Living (IL)—Blind program is available to adults of all ages whose independence is threatened because of vision loss. The predominant potential consumer group includes individuals who are older, or no longer able to work, and who are experiencing serious limitations in their functional capacities because of severe visual loss. To the extent that Texans who are blind or visually impaired live independently in their homes and communities, the need for publicly funded nursing care and assisted living is reduced. Likewise, blind individuals who have returned to the community from institutional settings find the adjustment and adaptive techniques offered by this program beneficial.
Projected prevalence rates for the IL—Blind program are included in Table 7.5. Projections are based on Texas data from respondents who describe themselves as having a serious vision loss, and who have difficulty in areas of self-care (e.g. dressing, bathing, or getting around inside the home). Even with these modified projections, the IL program continues to struggle to meet the needs of this ever-growing target population.
The IL—Blind program offers specialized services to help people avoid institutionalization and remain in the community. Services build confidence in living independently, primarily through adjustment to blindness and learning alternate ways to do daily tasks. A variety of services address the amount and kind of assistance needed, including:
- Information about vision loss, adjustment to blindness, adaptive techniques and special resources related to vision loss;
- Referral to other community resources related to aging, disability, and other individualized concerns;
- Group training to encourage self-confidence building experiences and to provide opportunities for "hands-on" application of adaptive techniques for everyday activities;
- One-on-one in-home adaptive skills training; and
- Peer support development.
In FY 2009, 3,490 people were served in this program.
Independent Living Services—General
IL consumers have significant disabilities resulting in a substantial impediment to their ability to function independently in the family and/or community. These individuals face barriers that severely limit their choices for quality of life. Some barriers are obvious, such as a curb with no ramp for people who use wheelchairs or a lack of interpreters or captioning for people with hearing impairments. Other barriers are often less obvious and can be even more limiting, such as inadequate or inaccessible housing, attendant care, or transportation. Unfortunately, misunderstandings about disability can prevent people with disabilities from living independent lives in their communities.
IL services contribute to the independence of people with disabilities in the community and support for their movement from nursing homes and other institutions to community-based settings.
The ILS – General and CILs provide a broad array of services promoting increased self-sufficiency and enhanced quality of life for persons with significant disabilities. With assistance from ILS—General, people with disabilities become more independent within their communities. Examples of IL services include counseling and guidance, durable medical equipment, communications aids, prostheses, rehabilitation technology, and IL skills training.
Consumers control the decision-making, service delivery, and management of community-based CILs, promoting practices that increase self-help, strengthen self-advocacy, and actively develop peer relationships and role models. Core CIL services include information and referral, IL skills training, peer counseling and individual and systems advocacy.
Service Population Projections for Independent Living Services
|FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
|IL Services—General Population||696,000||711,100||726,400||741,900||757,500||773,500|
|IL Services -- Blind||153,800||157,200||161,100||165.100||168,602||172,104|
Table 6.6: Department of Assistive and Rehabilitative Services, 2009.
Additional resources for ILS
The Texas population is growing, aging, and living longer, creating increasing needs for rehabilitation, and increasing the demand for IL services. The number of applicants to the IL services program is steadily increasing. The cost of services, especially medical services, is increasing significantly each year and straining program resources. Assistive technology, which enables consumers to live independently, is becoming more sophisticated in addressing more kinds of functional needs. At the same time, it is also becoming more expensive.
Compounding the increased demand is the rapid expansion of the Independent Living Centers (CILs). If a consumer needs services beyond those provided by CILs, they are referred to the IL program. IL counselors also spend extra time supporting multiple CILs, which decreases the time available to serve other consumers on their caseload. In addition, DARS provides technical assistance and oversight to centers receiving any state funds. Accordingly, without additional IL counselors, the waiting list can be expected to increase.
Blindness Education, Screening, and Treatment
The Blindness Education, Screening, and Treatment (BEST) program target population includes adult Texans who may be at risk for blindness because of untreated eye medical conditions such as diabetic retinopathy, glaucoma, and detached retina.
Created in 1997, the BEST program is designed to prevent blindness. Program functions involve two major activities: the provision of adult vision screening services to identify conditions that may cause blindness and payment for urgently needed eye medical treatment for adults who do not have health insurance or other resources to pay for the needed treatment. The BEST program is supported by Texans who donate a dollar when they renew their driver's license or Texas Department of Public Safety-issued identification card. In FY 2009, 7,741 individuals received vision screenings, and 168 received eye medical treatment.
BEST services are designed to reduce the number of Texans who lose their sight. By encouraging Texans to take care of their eyes and to seek professional care if they are at risk for potentially serious eye conditions and by assisting with medical treatment to prevent blindness, BEST helps Texans retain employment and support their families while saving federal and/or state funds that would otherwise be needed for rehabilitation and/or social services if blindness occurred. Further, because the program's sole source of funding is voluntary donations, the BEST program provides critically important services without requiring the use of federal or state resources.
The BEST program could be improved through availability of additional funding for more vision screening services and an increased number of treatment services. Currently, Texas Transportation Code provisions limit the public's ability to make BEST donations to only transactions that involve "issuance or renewal" of a license and/or identification card.
The annual dollar amount of voluntary donations to the BEST program would likely increase if the public had additional opportunities to make them. The Texas Department of Public Saftey's (DPS) authority to accept donations could be expanded to include transactions beyond "issuance or renewal" of a driver's license and/or identification card. Such opportunities would include, for example, situations where:
- an individual needs to apply for a duplicate license or ID card because of a change of name, a change of address, or a lost or stolen license or identification card;
- a licensed driver changes his or her existing license to add additional authorization or makes a change in classification (for instance, amending an existing license to include authorization to operate a motorcycle);
- an individual applies for, renews, or changes a commercial driver's license;
- an individual applies for, renews, or changes a provisional driver's license, instruction permit, or hardship license; or
- a person with a suspended license applies for a replacement license.
It is also important to ensure that opportunities to make voluntary donations to the BEST program include all applicable avenues for such transactions (in person, by mail, over the phone, via the Internet or other electronic means, etc.).
Deaf and Hard of Hearing Services
DARS serves Texans who are deaf or severely hard of hearing. DARS estimates that there are more than 875,000 persons in Texas in 2010 who are deaf or severely hard of hearing or 3.4 percent of the population6. The greater the extent and the earlier the onset of hearing loss, the greater the likelihood persons are to need and seek services. DARS projects the prevalence for the planning time period in Table 6.7.
The DHHS office promotes an effective system of services for individuals who are deaf or hard of hearing, and it evaluates and certifies interpreters. To facilitate the provision of specialized services to individuals who are deaf or hard of hearing, DARS contracts with community-based organizations that provide communication access and other services designed to remove barriers between individuals needing services and service providers in the communities. Such services include:
- Advocacy services;
- Outreach and education services;
- Interpreter services;
- Adjustment and hearing technology services for persons experiencing hearing loss;
- Computer assisted real-time transcription services (CART);
- Interpreter training, including Hispanic trilingual training and certified deaf interpreter training;
- Service provider training regarding the provision of services to individuals who are deaf or hard of hearing;
- Information and referral services;
- Vocational education and independent living services for individuals who are low-functioning deaf or hard of hearing; and
- Services to older persons to bridge communication barriers and reduce isolation.
DARS certifies interpreters of varying levels of skill and maintains lists of certified interpreters for courts, schools, service providers, and other interested entities. There are currently 1,762 certified interpreters in the state. DARS has developed new interpreter certification tests to replace tests that were used for 25 years. The new tests are valid and reliable. Highly skilled and certified interpreters are contracted to score the tests and determine the skill levels of individual candidates. Most interpreting situations require more advanced skills, and only 811, or 46 percent of the level interpreters, are certified at advanced levels. At least one-third of this higher certification group are working in administrative or teaching functions and are not readily available for interpreting. Only 144 or 8 percent of all interpreters are certified by DARS for interpreting in court. Additionally, new Hispanic trilingual interpreter tests will be used for the first time in 2010. The implications are discussed in the Trends and Initiatives section below.
DARS also administers the Specialized Telecommunication Assistance Program, authorized by the 75th Legislature. This voucher program, funded by the Universal Service Fund, provides telecommunication access equipment for persons who are deaf or hard of hearing, speech impaired, or who have any other disability that interferes with telephone access. During FY 2009, almost 24,000 vouchers were issued, of which 82 percent were for amplified telephones.
Projections of Deaf and Hard of Hearing in Texas (in thousands)
|FY 2010||FY 2011||FY 2012||FY 2013||FY 2014||FY 2015|
|Deaf or Hard of Hearing||875,838||893,041||910,587||928,368||946,961||965,747|
Table 6.7: Department of Assistive and Rehabilitative Services, 2009.
DARS Goal 2 Trends and Initiatives
DARS has an opportunity to continue providing education and training for consumers with diabetes. With training, consumers experience fewer complications resulting from diabetes and are in a better position to become employed, remain employed, and live more independently.
The prevalence of diabetes continues to increase. In 2008, approximately 1.7 million people in Texas were diagnosed with diabetes. People with diabetes have a greater risk of experiencing vision loss from diabetic retinopathy, cataracts, and glaucoma. Each year, as many as 25,000 people become blind as the result of diabetic retinopathy. Diabetes is the leading cause of blindness for adults ages 20 to 74.
Diabetes affects ethnic groups differently, with African-Americans and Hispanics having higher prevalence rates than Anglo-Americans. In addition, the Hispanic population is growing faster than other ethnic groups, which will likely impact the number of Texans who are diagnosed with diabetes and who may lose significant vision as a result of the disease. According to the American Diabetes Association, in 2006, the total cost of diabetes for Texas was estimated at $12.5 billion. This includes medical costs of $8.1 billion attributed to diabetes, and lost productivity valued at $4.3 billion.
Fortunately, significant improvement has been shown to be possible through rehabilitation programs educating people about diabetes self-management skills, nutrition counseling, and exercise programs.
Growing population of older Texans
DARS continues to be challenged by the disparity between the growing population of older people and limited program resources. Historically, the program has reached less than 2 percent of the population projected to be experiencing serious loss of vision. Other than American Recovery and Reinvestment Act (ARRA) funds available only in 2010 and 2011, resources have remained flat in the IL program. The number of consumers eligible for IL services continues to increase and the population currently being served tends to be younger. In fiscal year 2009, 62 percent of the individuals served were 55 years of age or older and 38 percent were younger than 55. This shift is critical because 88 percent of the federal funding for this program is targeted for individuals 55 and over.
ARRA funds are being used to meet the needs of consumers with multiple disabilities, including those requiring extensive mobility services. However, after ARRA funds are no longer available, additional funding will be necessary to continue meeting this need.
Shortage of Orientation and Mobility Specialists
The topic is currently being developed.
Increase in population of Individuals who are Deaf or Hard of Hearing
The population of individuals who are deaf or hard of hearing is growing, as is the demand for services (see Table 6.7). Currently, there are not enough Deafness Resource Specialists and Hearing Loss Resource Specialists in each Health and Human Services Commission Region. The current funding level for the Resource Specialist Program funds, at a minimum, one Deafness Resource Specialist (Deafness RS) contractor and one Resource Specialist (HLRS) contractor in HHSC Region. The limited number of specialists per region does not adequately serve this population, especially the high-population regions. The regions are huge and present an enormous responsibility for the limited number of specialists.
Approximately 3.4 percent of the Texas population, or a projected figure of 910,587 in FY 2012 and 928,368 in 2013, are considered to have a hearing loss. On average, a Deafness RS serves about 407 people per year; an HLRS serves about 742 people each year. Additionally, the cost for providing deaf and hard of hearing services is increasing while funding has not increased for six years.
The new BEI interpreter tests and Hispanic trilingual tests have increased the need for staff resources. Administering the new performance and written test takes an additional hour and 25 minutes. The trilingual interpreter tests, initiated in 2010, will increase the number tested by an estimated 60 individuals and involves a two hour written test and one hour performance test. Licensing the BEI general tests to other states has created more administrative time to oversee the implementation of testing and monitoring to ensure the tests remain valid and reliable through an ongoing statistical proves. The trilingual tests also involve significant statistical monitoring. As a result, existing staff are not able to adequately meet these new demands.
DHHS also has a number of specialized interpreter tests that have been in use for a number of years and need to be redeveloped for test quality and validation/reliability purposes. In addition, there is a need for a court interpreter test which is required by statute but lacks a performance test. To develop these tools requires additional funding.
Shortage of Sign Language Interpreters
The high demand for interpreters and the limited number and availability of certified interpreters, especially interpreters certified at higher levels of skill, have resulted in a severe shortage of interpreters qualified and available for meeting the needs of consumers in the communities. Currently, there are only 1,762 certified interpreters existing in the state of Texas. Approximately 46 percent of these interpreters are certified at the entry level, and most interpreting situations require more advanced interpreting skills.
Reasons for the shortage may include lack of awareness of interpreting as a career choice and the considerable amount of time, difficulty, and talent required to develop interpreter skills. Additionally, there are limited resources available to provide pre-service training opportunities for prospective interpreters and for entry-level interpreters to upgrade their skills. To increase the number of available qualified interpreters and to upgrade the skills of currently certified interpreters, the DARS Deaf and Hard of Hearing Services (DHHS) office is seeking to expand and strengthen relations with the Interpreter Training Programs across the state and the school districts that provide sign language programs. DHHS provides interpreter training that focuses on upgrading the skills of this large entry-level group, which helps to decrease the shortage.
Start up Funding for SOARS programs
The need for the Supportive Opportunities for At Risk Students (SOARS) program continues at community colleges. SOARS is a pilot project at the Southwest Collegiate Institute for the Deaf and is the only community college program in Texas that provides specialized services to students who are at-risk/low-functioning deaf. The project targets students with borderline academic preparedness and limited job readiness and provides tutoring, independent living training and counseling. Students with limitations have difficulty learning and need support services tend to drop out without being identified. According to a Galludet University article published in 1994, half of the seventeen and eighteen year old deaf and hard of hearing students left special education programs reading below the fourth grade level.7 Providing start-up funding in mainstream community colleges for SOARS would assist in appropriately identifying this target population and give the support needed to students.
To respond to this need, DARS is evaluating funding strategies, including an add-on fee for VR consumers, to increase the number of students who can benefit from this program.
Contracting for certain services
Contracting for certain services and additional supports creates opportunities to clear time for Vocational Rehabilitation Counselors and Rehabilitation Service Technicians from using time on non-core services and improve efficiency and the rehabilitation rate. Additionally, some tasks may be handled more successfully by contracting services since they would have more time to devote to the function and specialize in specific areas.
Non-core services are those services not required by statute to be provided by counselors or staff in direct support of counselor functions, but are nonetheless deemed important to service effectiveness, consumer retention and improved successful closure rates. Examples of services for which contracts could be developed include, switchboard functions, appointment reminder calls, and customer satisfaction calls.
DARS is piloting customer service calls through a contract with a call center. Call centers will make reminder calls to at-risk consumers, as well as follow-up calls after appointments to determine quality of services provided. The department will use this pilot to determine appropriate next steps in an effort to continue to employ innovative practices for long-term solutions.
DARS Goal 3: Disability Determination
DARS will enhance service to persons with disabilities by achieving accuracy and timeliness within the Social Security Administration Disability Program guidelines and improving the cost-effectiveness of the decision-making process in the disability determination services.
Disability Determination Services (DDS)
For Social Security purposes, disability means a medical condition preventing a person from working, or in the case of a child, preventing the child from engaging in age-appropriate activities. The medical condition must be so severe that it will last at least twelve continuous months or result in death, and it must be documented by objective medical evidence.
DDS administers two disability determination programs on behalf of the Social Security Administration (SSA). The first program, Social Security Disability Insurance (SSDI), is related to work. Workers earn coverage for themselves and family members by paying Social Security tax. The program covers workers who have a disability, widows/widowers who have a disability, and workers' adult children who have a disability.
The second program, Supplemental Security Income (SSI), is related to means —what a person earns and owns. People who meet the criteria for disability and have low incomes and few assets may qualify for SSI benefits, which supplement SSDI benefits.
When a person is not able to work due to a physical or mental impairment, that person may apply for federal SSDI and/or SSI disability benefits. Disability Determination Services (DDS) processes the applications for these benefits under an agreement between the state and SSA. SSA provides 100 percent of the funding.
Each application for SSDI/SSI disability benefits originates in an SSA field office and is forwarded to the DDS. There, it is developed and adjudicated by a trained claims examiner who reviews the disability forms and gathers medical evidence from the claimant's treating sources. Usually the examiner receives enough evidence from the applicant's medical sources to make a decision. If more evidence is needed, a consultative examination is arranged and paid for by the DDS with funds from the SSA.
The examiner and a DDS medical consultant team review all the information and determine whether an applicant is disabled as defined by SSA. In federal fiscal year (FFY) 2009, the DDS processed 209,817 initial cases, determining that 89,044 people, or 43.5 percent, met the SSA criteria for disability. For quality control, SSA reviews a sample of initial DDS determinations. In FFY 2009, the DDS achieved a 96.3 percent accuracy rate compared to the national average rate of 94.9 percent. After completion of the DDS adjudication process, the case is returned to the Social Security Field Office from which it was received, and the applicant is notified of the decision by mail. In FFY 2009, the Texas DDS average processing time for an initial case was 58.8 days compared to the national average of 80.7 days.
Applicants who have been denied benefits may request reconsideration, the first step in the appeal process. Reconsideration cases are reviewed in the DDS by a different examiner and doctor from those who processed the initial application. In FFY 2009, the DDS reviewed 48,943 reconsideration cases, of which 9,500, or 19.8 percent, were allowed, or reversed.
The DDS allowance rates for both initial and reconsideration cases were higher than the national average in FFY 2009. The national allowance rate for initial cases was 36.9 percent, and for reconsideration cases, it was 13.8 percent. This means that, in percentage terms, the Texas DDS determined claimants to be "disabled" at a rate above the national average. SSA has final authority to award or deny benefits.
Benefit Amounts as Reported by SSA
The State of Texas receives $699.1 million combined SSDI and SSI disability payments to disabled workers a month, as of December 2008. This does not include an additional $38 million paid each month to spouses and children of disabled workers.
DARS Goal 3 Trends and Initiatives
Increase in Disability Applications
The most significant trend impacting the DDS continues to be the increase in the number of SSA disability claims expected due to population growth, recession, and the aging of the baby boomers. As the population grows, so does the total number of disability claims filed. Further, as aging baby boomers reach a more vulnerable stage in life, they are more likely to apply for disability benefits in increasing numbers.
National disability claims rose 17 percent in FFY 2009 to more than 3 million, according to the Social Security Administration. It is projected to jump to 3.3 million in 2010. In Texas, the claims rose 16.5 percent in 2009, to 227,117 and are projected to rise to 312,070 in 2011.
SSA Projected Caseload for Texas Disability Determination Services
|FY 2010||FY 2011||FY 2012||FY 2013|
|Estimated Cases That Will Be Processed||302,393||353,238||363,835||374,750||385,993|
Table 6.8: Social Security Administration, 2010.
SSA and DDS have worked diligently to reduce workforce losses. Because it generally takes from two to three years for an examiner to become fully proficient in the job, efforts to hire and retain claims examiners are critical. SSA, with the assistance of DDS, led a nationwide project to identify recruitment and retention efforts and concerns within the State DDSs. This workgroup identified and prioritized more than 140 issues and developed recommendations to SSA for addressing the issue of recruitment and retention. As a result, the DARS DDS is implementing a hiring plan for Claims Examiners, State Agency Medical Consultants and support staff. To accomplish the SSA goals, DARS DDS anticipates hiring four Claims Examiner classes in FFY 2010 and additional State Agency Medical Consultants. Based on current attrition rates, this level of hiring will enable the department to increase staffing levels, which will be critical in order to produce the anticipated number of case receipts during FFY 2010.
Further, in an effort to accommodate the rapidly increasing case receipts over the next several years, DARS DDS has made SSA aware of the anticipated need for expansion of office space in 2011, based on current and projected hiring patterns.
Disability Case Processing System (DCPS)
For over the past two years, DDS Administrators representing each region, along with SSA executive staff representing the federal case processing partners, have been working together to create a common case processing system for all partners engaged in adjudicating disability decisions. The Disability Case Processing System (DCPS) eliminates the current five legacy vendor environment and will use a streamlined, common case processing environment to improve efficiency and accuracy, yet preserve excellent customer service. All 54 DDSs will use the system which will easily transfer information to and from Field Offices and other SSA units.
Customers and stakeholders are taking part in designing DCPS to ensure accurate decisions, timely and cost-effective case processing, optimum worker productivity, and improved employee job satisfaction.
Preparation for Social Security Administration (SSA) Predicted Caseload Surge
The projected surge in SSA claims resulting from the economic downturn and the baby boomer retirements are predicted to strain the existing system. In response, SSA, in partnership with DARS DDS, seeks to develop a comprehensive strategy to process these claims accurately and efficiently.
According to SSA, applications for Social Security benefits rose almost 50 percent more than expected in 2009. Agency statistics show that 2.57 million people requested benefits nationwide, a increase from the 2.10 million applications received during the previous twelve months.
In addition, SSA notes that national disability claims rose 17 percent this year, (FY 2009) to more than 3 million. It is projected to jump to 3.3 million in 2010. In Texas, the claims rose 16.5 percent in 2009, to 227,117 and are projected to rise to 312,070 in 2011.
Although SSA fully funds the DARS DDS program, DARS may need to request capital spending authority for any identified capital items. Failure to secure the required spending authority may jeopardize the department's ability to service claims from entitled disabled Texans.
DARS Internal Assessment
This section represents an evaluation of the key internal factors that influence DARS. Below is a discussion of the agency's internal processes and operations, its perceived strengths and challenges.
Maintaining and Developing the Workforce
Most organizations expend a great deal of energy to effectively plan for their future products, services, customers, and finances. Few organizations apply these techniques to the real source of ongoing effectiveness – human capital. The DARS succession planning project is designed to ensure the department continues to deliver excellent service by having a workforce with the competencies, attitudes and values needed today and into the future. This process will provide DARS management with accurate, complete, timely and relevant staffing and workforce information for future recruitment, training, retention and related succession planning activities designed to meet needs of consumers today and into the future.
Addressing Infrastructure Needs
The DARS Infrastructure and Development Platform Refresh Information Resources capital project supports the replacement and upgrade of hardware, mobile computing products, and software. Refreshing, replacing, and upgrading miscellaneous hardware and software is essential to the continued support of DARS and its programs. This includes adaptive software necessary for our staff with disabilities to thrive in their positions. Continuous improvement allows DARS to be current technology which is critical to supporting the agency's mission. The Infrastructure Refresh is an operational, routinely requested and approved capital project.
Also, unique to DARS is the maintenance of the Criss Cole Rehabilitation Center. With the age of the facility, there are numerous maintenance issues and increasing need for more efficiency in space utilization. DARS continues to improve work areas to increase energy efficiency, eliminate safety hazards, and provide increased security.
Improving Data Quality and Use
The topic is currently being developed.
The ECI service system in the present form is not sustainable and may not be delivering the benefits to children and families that lessen their dependence on special education and other state services over time. Many states are facing significant challenges as they continue to implement early intervention systems operating under Part C of the Individuals with Disabilities Education Act (IDEA). The ECI system is required to reach all the children eligible to receive services and provide all of the services they need. However, the system is currently challenged to do this for several reasons:
- significant growth in the number of children and families receiving services (approximately 7 percent each year)
- resource levels that do not support adequate service levels
- a complex contract payment structure with multiple federal, state, and local funding sources
Consequently, DARS is evaluating the ECI program. The goal of this evaluation is to develop recommendations for a sustainable ECI program that can effectively serve children and families. The evaluation will have several components, including:
- Input from parents, pediatricians, and program/clinical experts to identify aspects of the ECI system that are most important to children and families, strengths of the ECI system, and services that are not aligned with the program's priorities and strengths;
- Assess the gap between service needs and ECI service levels;
- Examine family cost share and co-pay policies; and,
- Evaluate and recommend changes to contract and payment structures and methods used to account for funding sources.
DARS conducted eight statewide meetings in January 2010 to allow stakeholders, especially families who have received ECI services, to share their ideas on how the department can most effectively use limited dollars to provide the services most important to children and families. The meetings also provided an opportunity for the public to comment on recommendations for potential changes to ECI eligibility criteria. The latter recommendations were developed by a small, diverse group of stakeholders in December 2008 in the event that there was no increase in funding for the program in the 2010-11 biennium.
In March 2010, DARS ECI contracted with a consultant to prepare a recommendation for a new contract structure and financing strategy for the Early Childhood Intervention program which will promote quality services, effectively use available funds, enhance the ability to access additional revenue and reduce administrative burden for contractors. Through a contractor, DARS will also conduct an analysis of the gap between the services that children and families need and current ECI service levels.
The information gathered through the evaluation will help DARS provide valuable information to State leaders as they consider funding and policy decisions.
Although DARS is not a primary emergency services agency, the agency is committed to working with the Texas Division of Emergency Management (TDEM), Health and Human Services agencies, and other Texas Emergency Management Council agencies in preparing for, responding to, and recovering from domestic and international threats, natural disasters, and critical vulnerable infrastructure disruptions that could impact Texas as well as DARS' ability to deliver services. DARS will continue to support the emergency response efforts of Health and Human Services partner agencies as per the Memorandum of Agreement among the agencies of the Texas Health and Human Services Enterprise Emergency Management Council.
Further, DARS is enhancing the Continuity of Operations (COOP) capability of the agency through the development of a comprehensive continuity program and standing steering committee comprised of key agency representatives. This program will enhance the capability of DARS, agency divisions and field offices to provide services during business disruptions and recover from such disruptions. In addition, the program will enhance the agency's ability to coordinate resources to support emergency response and will clearly identify the agency's internal procedures for specific threats such as a pandemic public health disaster.
DARS is also committed to working with the Texas Division of Emergency Management, Department of State Health Services and other lead State Emergency Management Council Agencies to enhance the preparedness of Texans through communication with stakeholders and providing review and comment on State and local template preparedness and planning efforts.
DARS Internal Strengths and Challenges
Vocational Rehabilitation Services to Rural Areas
Ongoing challenges exist to provide vocational rehabilitation services to Texans in rural areas. These services include Community Rehabilitation Program (CRP) services, vocational evaluations, psychological assessments and other assessments. CRP providers from larger metropolitan areas have attempted to provide services in rural areas, but often find doing so to be cost-prohibitive due to travel expenses. Additionally, some rural areas may not offer levels of business that providers find suitable or adequate to sustain business survival. In smaller rural areas, for example, a psychologist may only come to test consumers once they are guaranteed to test a certain minimum number. This leads to service delays. In addition, counselors in rural areas are forced to pay the expenses of sending a consumer from home to another location for assessments.
DARS has developed, and is piloting, strategies to encourage providers to travel to rural areas and provide needed services. These involve paying vendors' administrative fees and travel mileage. Additionally, DARS has contracted with the Center for Social Capital to develop staff and CRP expertise in customized self employment. Self employment is often an effective strategy for consumers in rural areas where limited hiring opportunities exist.
Management to Staff Ratio
The topic is currently being developed.
1 DVA, Office of Policy and Planning National Center for Veterans Analysis and Statistics, February 01, 2010
2 "Vocational Rehabilitation Funding Formula: Options for Improving Equity in State Grants and Considerations for Performance Incentives." United States Government Accountability Office, September 2009.
3 Brigitte Volmer, et. al., "Predictors of Long-term Outcome in Very Preterm Infants: Gestational Age Versus Neonatal Cranium Ultrasound," Pediatrics, November 2003.
4 Texas Education Agency, Registration Report.
5 Children in Texas aged 3 through 8 with a diagnosis on the autism spectrum.
6 Texas Health and Human Services Commission demographers analyzed data obtained from the American Community Survey for Texas and the National Health Interview Survey, in addition to population estimates developed by the Texas State Data Center, to develop estimates of the population in need for the Deaf and Hard of Hearing program.
7 Galludet University, 1994. "A Comprehensive Evaluation of the Postsecondary Educational Opportunities for Students who are Deaf or Hard of Hearing." Funded by the United States Office of Special Education.